Functional biomarkers able to identify multiple sclerosis (MS) patients at high risk of fast disability progression are lacking. The aim of this study was to evaluate the ability of multimodal (upper and ... [more ▼]

Functional biomarkers able to identify multiple sclerosis (MS) patients at high risk of fast disability progression are lacking. The aim of this study was to evaluate the ability of multimodal (upper and lower limbs motor, visual, lower limbs somatosensory) evoked potentials (EP) to monitor disease course and identify patients exposed to unfavourable evolution. One hundred MS patients were assessed with visual, somatosensory and motor EP and rated on the Expanded Disability Status Scale (EDSS) at baseline (T0) and about 6 years later (T1). The Spearman correlation (rS) was used to evaluate the relationship between conventional EP scores and clinical findings. Multiple (logistic) regression analysis estimated the predictive value of baseline electrophysiological data for three clinical outcomes: EDSS, annual EDSS progression, and the risk of EDSS worsening. In contrast to longitudinal correlations, cross-sectional correlations between the different EP scores and EDSS were all significant (0.33 ≤ rS < 0.67, p < 0.001). Baseline global EP score and EDSS were highly significant predictors (p < 0.0001) of EDSS progression 6 years later. The aseline global EP score was found to be an independent predictor of the EDSS annual progression rate (p < 0.001), and of the risk of disability progression over time (p < 0.005). Based on a ROC curve determination, we defined a Global EP Score cut off point (17/30) to identify patients at high risk of disability progression illustrated by a positive predictive value of 70 %. This study provides a proof of the concept that electrophysiology could be added to MRI and used as another complementary prognostic tool in MS patients. [less ▲]

A total of 154 adult patients with sleep complaints underwent a polysomnography and a craniofacial cone beam computed tomography (CBCT). OSA was defined as an apnea and hypopnea index (AHI) or an oxygen ... [more ▼]

A total of 154 adult patients with sleep complaints underwent a polysomnography and a craniofacial cone beam computed tomography (CBCT). OSA was defined as an apnea and hypopnea index (AHI) or an oxygen desaturation index (ODI) + or = 10. Soft tissues and craniofacial bones volumes were prospectively measured by CBCT and collected blindly from sleep polysomnography. Among the study patients, 127 (83%) suffered from OSA and 27 (17%) did not. OSA patients demonstrated a narrower maxillo-palatine core volume (11.7 + or - 3.2 vs 14.6 + or - 4.9 cm3) even when adjusting for age, gender, height, neck circumference and body mass index. These upper airway measures provide a comprehensive analysis of bony structures and soft tissues, which can be involved in OSA. [less ▲]

AIM OF THE STUDY: The lack of traceability and monitoring of blood donors and transfused patients constitute a barrier to the most basic rules of haemovigilance and overall good transfusion practices ... [more ▼]

AIM OF THE STUDY: The lack of traceability and monitoring of blood donors and transfused patients constitute a barrier to the most basic rules of haemovigilance and overall good transfusion practices. This study draws up an inventory of knowledge, attitudes and clinical practice of blood prescribers in Niamey. MATERIALS AND METHODS: A questionnaire was administered to 180 prescribers of blood products in Niamey in 2011. Questions were related to basic informations on blood transfusion and clinical use of blood. Analyses were performed using SAS 9.3 version. RESULTS: The sample consisted of 180 respondents from several professional categories: 51 physicians (28.33%), 10 medical students (5.56%), 84 nurses (46.67%), 15 anaesthesiologist assistant (8.33%) and 20 midwives (11.11%). Among these, 22.2% received training in blood transfusion safety. Half of the respondents (50.8%) got between 50 and 75% of correct answers, 45.8% got less than 50% correct while 3.35% scored more than 75% correct answers. The overall quality of responses was higher among physicians compared to other prescribers (P<0.0001); among respondents who received training in transfusion safety (P<0.0001); and among males (P=0.0306). For some items, subjects with more experience scored the best. CONCLUSION: The level of knowledge is still inadequate. More training in transfusion practices is necessary for prescribers of blood products. Accompanying measures to improve transfusion practice must be considered or strengthened through assessments, knowledge update/upgrade (regular, ongoing training) and establishment of active and motivated hospital transfusion committees. [less ▲]

in European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology (2016), 35(9), 14951500

This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was ... [more ▼]

This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liege, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 +/- 10.4 % vs. 90.3 +/- 6.6 %, p = 0.0013; antibiotics documented 87.9 +/- 9.0 % vs. 95.6 +/- 5.1 %, p < 0.0001; and duration or review date documented 31.9 +/- 15.4 % vs. 67.7 +/- 15.2 %, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators. [less ▲]

BACKGROUND: There is evident benefit in terms of reduced aneurysm related mortality from screening programmes of abdominal aortic aneurysm (AAA) in men aged 65 and more. Recent studies in UK and Sweden ... [more ▼]

BACKGROUND: There is evident benefit in terms of reduced aneurysm related mortality from screening programmes of abdominal aortic aneurysm (AAA) in men aged 65 and more. Recent studies in UK and Sweden have shown a decline of the prevalence of AAA in the general population. Current screening policies (e.g. men aged 65-74 years) however do not account for ageing and increased life expectancy of western populations. This study investigated AAA detection by extending the target population to older age groups (75-85 years). METHODS: AAA screening was conducted in the County of Chaudfontaine (Liege, Belgium) on the population of elderly (N=3,054). The participation rate was 36%. The 1,101 participants (722 men aged 65-85 and 379 women aged 74-85 years) were examined by ultrasound (US) scan. AAA was defined as an infrarenal aortic outer-outer diameter of at least 3 cm. Demographics, clinical parameters and risk factors were also recorded. AAA prevalence was estimated and patients with and without AAA were compared by logistic regression. RESULTS: The overall AAA prevalence was 3.6% (n=40). In female participants, AAA prevalence was low (1.3%). In men, it amounted 2.7% in the 65-74 age group but rose to 7.3% in the age-extended group (75-85 years). Further in addition to age, height, current smoking, history of coronary artery disease, hypercholesterolemia, peripheral artery disease of the lower limbs and varicose veins were significantly associated with the presence of AAA. CONCLUSION: These preliminary findings, based on a representative sample of the elderly population of the Liege region, support the idea that current AAA screening policies should be updated to cover an increasingly ageing population. The presence of varicose veins as a potential risk factor for AAA should also be considered during screening. [less ▲]

OBJECTIVE: Treating metastatic colorectal cancer with anti-EGFR monoclonal antibodies is recommended only for patients whose tumour does not harbour mutations of KRAS or NRAS. The aim of this study was to ... [more ▼]

OBJECTIVE: Treating metastatic colorectal cancer with anti-EGFR monoclonal antibodies is recommended only for patients whose tumour does not harbour mutations of KRAS or NRAS. The aim of this study was to investigate the biology of rectal cancers and specifically to evaluate the relationship between fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography (PET) intensity and heterogeneity parameters and their mutational status. METHODS: 151 patients with newly diagnosed rectal cancer were included in this retrospective study. All patients underwent a baseline 18F-FDG PET/CT within a median time interval of 27 days of tumour tissue sampling, which was performed before any treatment. Standardized uptake values (SUVs), volume-based parameters and texture analysis were studied. We retrospectively performed KRAS genotyping on codons 12, 13, 61, 117 and 146, NRAS genotyping on codons 12, 13 and 61 and BRAF on codon 600. Associations between PET/CT parameters and the mutational status were assessed using univariate and multivariate analysis. RESULTS: 83 (55%) patients had an RAS mutation: 74 KRAS and 9 NRAS, while 68 patients had no mutation (wild-type tumours). No patient had BRAF mutation. First-order features based on intensity histogram analysis were significantly associated with RAS mutations: maximum SUV (SUVmax) (p-value = 0.002), mean SUV (p-value = 0.006), skewness (p-value = 0.049), SUV standard deviation (p-value = 0.001) and SUV coefficient of variation (SUVcov) (p-value = 0.001). Both SUVcov and SUVmax showed an area under the curve of 0.65 with sensitivity of 56% and 69%, respectively, and specificity of 64% and 52%, respectively. None of the volume-based (metabolic tumour volume and total lesion glycolysis), nor local or regional textural features were associated with the presence of RAS mutations. CONCLUSION: Although rectal cancers with KRAS or NRAS mutations display a significantly higher glucose metabolism than wild-type cancers, the accuracy of the currently proposed quantitative metrics extracted from 18F-FDG PET/CT is not sufficiently high for playing a meaningful clinical role. ADVANCES IN KNOWLEDGE: RAS-mutated rectal cancers have a significantly higher glucose metabolism. However, the accuracy of 18F-FDG PET/CT quantitative metrics is not as such as the technique could play a clinical role. [less ▲]

ABSTRACT Background: Right ventricular remodeling due to pulmonary stenosis increases morbidity in children. Its pathophysiology needs to be clarified. METHODS: Six newborn lambs underwent pulmonary arterial banding, seven sham operation. mRNA encoding for cytokines, growth factors and regulators of apoptosis was sequentially measured in myocardium and blood before and up to 12 weeks postoperatively. RESULTS: Experimental animals showed hypertrophy and fibrosis of the right ventricular myocardium, myocardial over-expression of CT-1-mRNA and higher blood concentrations of mRNA encoding for VEGF, TGF-beta, Bak and BcL-xL than controls, respectively. CONCLUSION: Neonatal pulmonary stenosis leads to myocardial hypertrophy that is associated with CT-1 gene expression and with activation of growth- and apoptosis pathways in blood cells. [less ▲]

Background. Though the influence of physical activity in preventing cardiovascular diseases is well documented, only a few comparative studies have determined the degree of adherence to physical activity ... [more ▼]

Background. Though the influence of physical activity in preventing cardiovascular diseases is well documented, only a few comparative studies have determined the degree of adherence to physical activity recommendations among populations and identified the demographic, socioeconomic, behavioural and health-related factors associated with good compliance. Design and methods. Cross-sectional interregional NESCaV survey of 3133 subjects compared three populations, Luxembourg, Lorraine (France) and Wallonia (Belgium), by using the International Physical Activity Questionnaire. Age and gender prevalence rates of physical activity were standardized to the European population. Results. The likelihood to meet the recommendations was higher in Luxembourg, after adjustment for age, gender, education, employment, weight status, morbidity score, health perception and level of importance attributed to the practice of physical activity (P<0.0001). The odds for meeting the recommendations were significantly higher among those with secondary than tertiary education. Compared to good self-health perception, subjects with poor or fair self-perceived health were less likely to meet the recommendations; this also applied to those attributing little or enough importance to physical activity compared with great importance. Conclusions. Region, education, self-perceived health and perception of importance of physical activity were emerged as independent determinants of meeting the recommendations. Awareness of the positive health effects of physical activity might thus be crucial for motivating the people to become more active. Further research is needed to explore potential region-specific factors which might explain the difference in population behaviours with respect to physical activity. [less ▲]